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Symptoms

Lewy body dementia (LBD) has variable presentations that include cognitive difficulties associated with motor dysfunction, perceptual disturbances, and/or sleep/wake cycle alterations. Cognitive impairment in Lewy body dementia (LBD) is often misdiagnosed as Alzheimer’s disease (AD). However, LBD has some unique cognitive features, such as early and significant deficits in executive function, visuospatial perception, speed of thinking, attention, and memory. Fluctuations in cognition and alertness are also common.

Other symptoms more easily help differentiate LBD from Alzheimer’s disease:

Movement symptoms resemble Parkinson’s disease and include lack of facial expression, slowed general mobility, stooped posture, precarious balance and tendency to fall when walking, shuffling gait, and tremor at rest.

Recurrent visual hallucinations of people, insects and animals may appear early in LBD. Delusions (i.e., fixed false beliefs), apathy (i.e., lack of initiative), agitation and depression are also common.

REM sleep behavior disorder (i.e., vivid dreams with verbal or physical dream enactment) is a common precursor, sometimes occurring years before the onset of the typical motor and cognitive symptoms. Other sleep disorders are also common, such as excessive daytime sleepiness, insomnia and restless leg syndrome.

Severe autonomic dysfunction may result in seemingly unrelated symptoms like orthostatic hypotension, syncope, or constipation.